Undiagnosed Primary Hyperparathyroidism and Recurrent Miscarriage: The First Prospective Pilot Study

• Published in: World journal of surgery Vol. 42; no. 3; pp. 639 - 645
• Main Authors: DiMarco, Aimee, Christakis, Ioannis, Constantinides, Vasilis, Regan, Lesley, Palazzo, F. Fausto
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Abortion, Habitual - epidemiology; Abortion, Habitual - etiology; Adult; Calcium; Calcium - blood; Calcium phosphates; Cardiac Surgery; Complications; Ethical standards; Female; General Surgery; Gestation; Humans; Hyperparathyroidism; Hyperparathyroidism, Primary - complications; Hyperparathyroidism, Primary - diagnosis; Hyperparathyroidism, Primary - epidemiology; Incidence; Male; Medicine; Medicine & Public Health; Miscarriage; Nutrient deficiency; Original Scientific Report; Parathyroid hormone; Parathyroid Hormone - blood; Parathyroidectomy; Patients; Phosphates; Pilot Projects; Pregnancy; Pregnancy complications; Prevalence; Prospective Studies; Surgery; Thoracic Surgery; United Kingdom - epidemiology; Vascular Surgery; Vitamin D; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - epidemiology; Vitamin deficiency; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4395-7

Background Primary hyperparathyroidism (pHPT) in pregnancy is reported to be associated with significant maternal and foetal complications and an up to threefold increase in the risk of miscarriage. However, the true incidence of pHPT in pregnancy, complete and miscarried, is unknown and there are no data on the prevalence of undiagnosed pHPT in recurrent miscarriage (RM) (≥3 consecutive miscarriages under 24-week gestation). This is the first prospective study aiming to establish the prevalence of undiagnosed pHPT in RM. Methods Following UK National ethics committee approval, women who had experienced 3 or more consecutive miscarriages were recruited from a nationwide RM clinic. Serum corrected calcium, phosphate, PTH and vitamin D were evaluated. Patients with raised serum calcium and/or PTH were recalled for confirmatory tests. Power calculations suggested that a minimum of 272 patients were required to demonstrate a clinically significant incidence of pHPT. Results Three hundred women were recruited, median age 35 years (range 19–42). Eleven patients had incomplete data, leaving 289 patients suitable for analysis; 50/289 patients (17%) with abnormal tests were recalled. The prevalence of vitamin D deficiency (<25 nmol/l) and insufficiency (25–75 nmol/l) was 8.7 and 67.8%, respectively. One patient was diagnosed with pHPT (0.34%) and underwent successful parathyroidectomy. Conclusions The prevalence of undiagnosed pHPT (0.34%) in RM in this study appears to be many times greater than the 0.05% expected in this age group. The findings of this pilot study merit follow-up with a larger-scale study. Routine serum calcium estimation is not currently undertaken in RM and should be considered.